Prevalence of diabetic dyslipidaemia in younger age group

Background: The commonest cause of mortality & morbidity in Type 2 diabetes is cerebrovascular accident & coronary artery disease. The study shows that only good blood glucose control, along with BP control in Type 2 diabetic patients cannot reduce mortality & morbidity due to cerebrovascular accident & coronary artery disease; but dyslipidaemia & life style modification is the cornerstone to reduce mortality & morbidity for those events. Dyslipidaemia in diabetes mellitus is a common accompaniment. Prevalence of lipid profile abnormality may not uncommon in young Type 2 diabetics which is common in elderly Type 2 diabetic patients. Aims: The aim of the study is to look after the prevalence of dyslipidaemia in younger age group & to compare it with elderly age group with the same anthropometric parameters. Methodolgy: A prospective cohort study was undertaken to find out the prevalence of diabetic dyslipidemia in younger and adult age group among patients attending Medical OPD & Diabetic clinic in M.G.M. Medical college &L.S.K. Hospital, Kishanganj, Bihar& to compare it between young and adult age group. Results: In the present study majority of patients of older age group have high LDL and low HDL in comparison to younger age group. Increased triglyceride level is not significantly high. Conclusion: Aggressive therapy of diabetic dyslipidemia will probably reduce the risk of CHD in patients with diabetes. Primary therapy should be directed first at lowering LDL levels & improving HDL levels. Correspondence to: Dr. Indranil Dawn, Department of Biochemistry, Malda Medical College & Hospital, West Bengal, India, email: dawn.indranil@gmail.com 1. Dr Susmita Sarkar, 2. Dr. Indranil Dawn Department of Biochemistry, Malda Medical College & Hospital Bangladesh Journal of Medical Science Vol. 16 No. 04 October’17. Page : 557-563 Introduction: Diabetes is the common cause of mortality & morbidity in all over the World. The global prevalence of Type 2 diabetes will be double between 1995 & 2025, to 270 million people with the greatest number of cases being expected in China & India1.Type 2 diabetes is the common form of diabetes accounting for 85% – 95 % of all cases of diabetes worldwide, and affecting 5% 7% of the World’s population. Increased prevalence of type 2 diabetic patients has been reported among overweight & obese persons as a consequence of unhealthy lifestyle2. the prevalence of Type 2 diabetes in India is up to 20% in adult population in some urban areas. The commonest cause of mortality & morbidity in Type 2 diabetes is cerebrovascular accident & coronary artery disease. The study shows that only good blood glucose control, along with BP control in Type 2 diabetic patients cannot reduce mortality & morbidity due to cerebrovascular accident & coronary artery disease; but dyslipidaemia& life style modification is the cornerstone to reduce mortality & morbidity for those events. Dyslipidaemia in diabetes mellitus is a common accompaniment. Diabetic dyslipidemia is increased VLDL / serum triglycerides decreased HDL average levels of LDL but with a predominance of small, dense LDL Diabetic dyslipidemia is due, largely, to insulin resistance, insulin resistance increases hepatic secretion of VLDL → preferential formation of small, dense LDL increases HDL catabolism (cholesterol ester transfer protein dependent effect) decreases LPL activity.3 Diabetic dyslipidemia typically comprises moderately increased triglyceride, low high density


Introduction:
Diabetes is the common cause of mortality & morbidity in all over the World.The global prevalence of Type 2 diabetes will be double between 1995 & 2025, to 270 million people with the greatest number of cases being expected in China & India 1 .Type 2 diabetes is the common form of diabetes accounting for 85% -95 % of all cases of diabetes worldwide, and affecting 5% -7% of the World's population.Increased prevalence of type 2 diabetic patients has been reported among overweight & obese persons as a consequence of unhealthy lifestyle 2 .the prevalence of Type 2 diabetes in India is up to 20% in adult population in some urban areas.The commonest cause of mortality & morbidity in Type 2 diabetes is cerebrovascular accident & coronary artery disease.
The study shows that only good blood glucose control, along with BP control in Type 2 diabetic patients cannot reduce mortality & morbidity due to cerebrovascular accident & coronary artery disease; but dyslipidaemia& life style modification is the cornerstone to reduce mortality & morbidity for those events.Dyslipidaemia in diabetes mellitus is a common accompaniment.Diabetic dyslipidemia is increased VLDL / serum triglycerides decreased HDL average levels of LDL but with a predominance of small, dense LDL Diabetic dyslipidemia is due, largely, to insulin resistance, insulin resistance increases hepatic secretion of VLDL → preferential formation of small, dense LDL increases HDL catabolism (cholesterol ester transfer protein dependent effect) decreases LPL activity. 3][6] The management of diabetic dyslipidemia should aim for all the lipoprotein abnormalities identified and is based upon a stepwise type of treatment, starting with lifestyle modifications and improvement of glycemic control.Lipid-lowering drugs should be used when targets are not met with the previous measures. 7he management of Type

Biochemical Parameter:
Blood sample collection: Blood sample was collected from the ante cubical vein with proper asepsis.Fluoride containing vials were used for collection of sample for plasma glucose estimation and for Lipid profile plain vials were used.Sample transferred to the Department of Biochemistry with in 2 hours maintaining cold chain.Subjects were selected after filling up the questionnaire.The study subjects also were asked to get prepare themselves as per advice, before the blood samples were drawn.At the initial steps, the Serum was separated by centrifugation and then subsequent investigation procedure was followed.A. Estimation of Fasting Blood Sugar: Principle: Glucose is oxidized to gluconic acid and hydrogen peroxide in the presence of glucose oxidases.Hydrogen peroxide further reacts with phenol and 4-aminoantipyrine by the catalytic action of peroxidase to form a red colored 'quinoneimine dye complex'.Intensity of the color formed is directly proportional to the amount of glucose present in the sample. 11B. Estimation of Triglyceride : Principle: Lipoprotein lipase hydrolyses triglycerides to glycerol and free fatty acid.The glycerol formed with ATPin the presence of glycerol kinase forms glycerol 3 phosphates, which is oxidized by the enzyme glycerol phosphate oxidase to form hydrogen peroxide.Hydrogen peroxide further reacts with phenol and 4aminoantipyrine by the catalytic action of peroxidase to form a red colored 'quinoneimine dye complex'.Intensity of the color formed is directly proportional to the amount of triglycerides present in the sample. 12. Estimation of Cholesterol : Principle: Cholesterol esterase hydrolyses esterified cholesterols to freecholesterol.The free cholesterol is oxidized to form hydrogen peroxidewhich further reacts with phenol and 4-aminoantipyrine by the catalyticaction of peroxidase to form a red colored quinoneimine dye complex.Intensity of the color formed is directly proportional to the amount of cholesterol present in the sample.Cholesterol Esterase.13 D. Estimation of HDL Cholesterol : Principle: When the serum is reacted with the Polyethylene Glycol contained in the precipitating reagent, all the VLDL and LDL are precipitated.HDL remains in the supernatant and is then assayed as a sample for cholesterol using standard cholesterol reagent.14 Data Analysis: Data analysis was done using SPSS 10.Package.

Limitations of the Study:
1. Maturity Onset Diabetes in Young (MODY) could not be excluded totally due to lack of proper investigating tools.2. Thorough diet survey could not be done due to time constraint.Lipid values, especially high-density lipoprotein cholesterol, hypertension, and other CHD risk factors were more strongly associated with CHD than glucose status. 15The Framingham Data 16 shows that the relationship between total cholesterol level and allcause mortality was positive (ie, higher cholesterol level associated ).In our study the TG level is not significant, however elevated levels of plasma triglycerides (TG) and reduced concentrations of HDL cholesterol are very common in patients with diabetes, particularly NIDDM. 21 significant component of the risk associated with type 2 diabetes is thought to be because of its characteristic lipid "triad" profile of raised small dense low-density lipoprotein levels, lowered highdensity lipoprotein, and elevated triglycerides (TGs). 22ongitudinal epidemiology has pointed to the importance of raised plasma triglycerides and low HDL Cholesterol as a risk factor for coronary disease in diabetic subjects and there is supportive evidence for aggressive management of lipid disorders in type 2 diabetes.

Proposed Therapeutic Goals for Men and Women with Type 2 Diabetes Lipid Fractions Ideal goal (mg/dL)
2 diabetes not only depends upon blood glucose control & blood pressure control, but life style management like obesity, exercise & also lipid profile management.Type 2 DM is becoming common in younger age group and the management is not depended upon blood glucose control only as mentioned and lipid profile abnormality is common in Type 2 diabetic patients.Prevalence of lipid profile abnormality may not uncommon in young Type 2 diabetics which is common in elderly Type 2 diabetic patients.Because younger age groups require longer No subjects were on hypolipidemic drugs.2. Alcoholic Type 2 diabetic patients being excluded from the study.3. Type 2 diabetic patients with noncomparable anthropometric measurements being excluded from the study.Case a Optional goal for very-high-risk individual: <70.10   10Sonography of pancreas.All patients were euthyroid.2) Exclusion Criteria:1.

Defining Criteria Used: Diabetic Dyslipidemia :
10abetic dyslipidemia is increased VLDL / serum triglycerides decreased HDL average levels of LDL but with a predominance of small, dense LDL Diabetic dyslipidemia is due, largely, to insulin resistance.Insulin resistance increases hepatic secretion of VLDL → preferential formation of small, dense LDL increases HDL catabolism (CETP dependent effect) decreases LPL activity.10ValidityandReliability:The schedule was presented before the experts of the relevant departments of the M.G.M. Medical College, Kishanganj (i.e., Biochemistry and Medicine & Ethical Committee) .

Table 1
Shows that 44 % of the study population have desirable cholesterol level, 14 % are in borderline and 42 % have high cholesterol level.

Table 4 : Distribution of total cholesterol according to income
level and no people of less than 25 years have very high LDL cholesterol level.The comparison is highly significant (<0.05).

Table 5 : Distribution of HDL cholesterol according to age-group
Shows that 12 % of less than 25 years age group have high HDL and only 6% of more than 60 years age group have high HDL.The comparison is highly significant (<0.05).

Table 6 : Distribution of triglycerides in the study population according To age-groups
with higher mortality) at age 40 years, negative at age 80 years, and negligible at ages 50 to 70 years.The result is similar to us.
age group have high triglyceride level high.Total cholesterol is increasing in higher income and urban area group than low income group and rural area.Diabetes mellitus increases the risk for atherosclerotic vascular disease.The risk is greatest in people who have other known risk factors, such as, dyslipidaemia, hypertension, smoking and obesity.There is a twofold to fourfold excess risk of coronary artery disease in type 2 diabetes mellitus compared with non-diabetic patients.Indeed, 75-80% of adult diabetic patients die of coronary artery disease, cerebrovascular disease, peripheral vascular disease or a combination of these conditions.Patients with type 2 diabetes can have many lipid abnormalities, including hyperchylomicronaemia, elevated levels of very low-density lipoprotein cholesterol (VLDL-C),low-density lipoprotein cholesterol (LDL-C) and triglycerides; and low levels of high-density lipoprotein cholesterol (HDL-C).Lipid abnormalities may be the result of the unbalanced metabolic state of diabetes (i.e., hyperglycaemia and insulin resistance) and improved control of hyperglycaemia does moderate diabetes-associated dyslipidaemia.In type 2 diabetes the major disturbances in lipoprotein metabolism are reflected by an increase in plasma triglyceride and a low HDL Cholesterol with normal or near normal LDL Cholesterol levels.Aggressive therapy of diabetic dyslipidemia will probably reduce the risk of CHD in patients with diabetes.Primary therapy should be directed first at lowering LDL levels & improving HDL levels.